Minimally invasive aesthetics

Some years ago, a patient requested me to do something about his diastemas and brighten up his smile. At the time my armamentarium was limited to porcelain jacket crowns and conventional veneers. As all his anteriors, canines and premolars were perfectly healthy, I was reluctant to propose invasive procedures.

This attitude has probably cost me a lot of work during my professional career, but I have always treated healthy dentine and enamel as something sacred. Having explained all of this to the patient, we agreed to accept the status quo for the time being.

Earlier this year a course in Lumineers was advertised in the Journal of Private Dentistry. ‘No-prep veneers, as thin as a contact lens.’ It sounded too good to be true, but I decided to gamble the time and money to find out if this could be what I had been waiting for throughout my professional career.

It was the first Lumineers course outside the USA, and I was more than impressed and I immediately recalled my patient for assessment and discussion. This being a difficult case, I realised that it would probably be pushing the limits of the conservative approach to the extreme, so I sent study models and photographs to the Cerinate Design Studio in Santa Monica for assessment and advice.

A week later I received a conference call from Dr Ibsen, the president of the Denmat Corporation, sharing the line with four other Lumineers experts. We discussed the case at length, and it was decided that we could indeed follow the minimally-invasive route.

Articulation facets on the canines indicated that considerable forces were at work during protrusive and lateral excursions, so some reduction was needed on the mandibular canines and anteriors. Cerinate porcelain is designed to be considerably stronger than any other porcelain, so as little as 0.3mm was necessary for conventional Lumineers, but to cope with the guidance forces, more was needed on the contacts.

During the first appointment, minimal modification was made to the disto-labial surfaces of the upper left and upper right central incisors. No other maxillary teeth were modified. The mandibular teeth were anaesthetised, and under 4x magnification, the labio-incisal surfaces of the coronal half of the mandibular canines and anteriors were modified, with minimal dentine being exposed. In less radical cases, no anaesthesia is needed, and often no prepping is required.

Standard impression trays were filled with heavy body PVS, and covered with a thin plastic wrap. This resulted in well-fitting customised trays, in which final impressions were taken with light-bodied First Impression paste. The total chair-time, including photography, was one hour and five minutes.

Five weeks later, the Lumineers arrived and the patient was booked for a full morning appointment. Placement, finishing and photography was completed in two hours 15 minutes, and the patient was given a further appointment two days later, for final balancing and finishing.

Dr Leon Karel Marè was born in in Nelspruit in the Eastern Lowveld, South Africa. He graduated from the University of Pretoria in 1977 and, in 2002, moved to the UK. Dr Marè maintains a private practice in New Milton called Greenfern Dental Care. In 2004, it was shortlisted by Private Dentistry magazine as one of the six best new practices in the UK.

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